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Friday, June 17, 2005

Cancer scanners sit idle in Ontario

New diagnostic tools more efficient
But PET scans not covered by OHIP

Rob Ferguson and Karen Palmer
Staff Reporters

Colon cancer survivor Howard Steinberg figures it's the best $2,500 he ever spent.

Told after a checkup and CT scan in February that cancer had returned as two nasty lesions on his liver, he was given three choices: surgery, heavy-duty chemotherapy or wait to die.

Shocked, he chose none of the above and hit the Internet. The 39-year-old learned how PET scans can pinpoint some cancers or rule them out better than other diagnostic imaging tools such as CT scans, MRIs and ultrasounds.

So he phoned a private company called Care Imaging in Mississauga and booked an appointment. Two days later, he was getting a PET scan.

"The results showed there was no cancer in my body, let alone my liver," said the Bay St. banker, relieved to avoid more medical treatment that would have been hard on him and Ontario taxpayers.

Now he's backing nuclear medicine physicians in their demand that the Ontario government move faster to make PET scans — short for positron emission tomography — available under provincial health insurance.

The PET scan lobby will get an added push next week when international nuclear medicine specialists meet in Toronto for a major convention.

"It's a good test to tell you where cancer has spread and where it has not spread," said Dr. Chris O'Brien, president of the Ontario Association of Nuclear Medicine.

"There's a lot of people that could benefit from it."

The specialists want Ontario to suspend clinical trials of PET scans at several hospitals and begin funding under OHIP for scans in six kinds of cancer patients in accordance with worldwide standards.

That list involves suspected recurrences of colon cancer like Steinberg's, some lung cancers, lymphoma, melanoma, head and neck tumours, and breast cancer.

"We felt that patients in Ontario should have similar access as is found in the rest of Canada," said O'Brien.

"Studies have shown approximately 30 per cent of patients will have their care management changed as a result of a PET scans," finding cancers earlier or ruling them out, O'Brien added.

The PET scans are also used in diagnosing heart disease and neurological disorders like Alzheimer's.

Ontario currently has seven PET scanners, which look at the body's molecular make-up to detect minute cancer cells. Ontario's machines equal the number now in the rest of Canada combined, but the only way to access them is to be enrolled as a trial patient or apply for a test on compassionate grounds and have the hospital pick up the cost.

"Most of these PET units are sitting idle, collecting dust," O'Brien said, estimating the machines could handle up to 12 scans a day at a cost of $1,500 to $2,000 each.

Not everyone is sold on the virtues of PET scans, saying it's too early to rush them into wider service without further study.

For almost a year, doctors at four sites in Toronto, Ottawa and Hamilton have been testing the machines — which cost about $3 million each — to determine whether they change the way doctors treat cancer patients.

"What we don't have are studies that show if it makes a difference in clinical management, which is really what the bottom line is, isn't it?" said Dr. Bill Evans, a provincial liaison on the testing of the machines.

Although the province expected to scan close to 600 patients in the first year of the trials, flaws in the study design meant they've scanned only about 150 patients so far, O'Brien said.

Alberta plans to have four machines running by the end of next year, treating between 7,000 and 9,000 patients, while British Columbia plans to scan 3,000 patients each year. Nova Scotia announced yesterday it would invest $5.5 million in PET technology. Quebec plans to install another 10 machines, allowing the province to treat 25,000 patients within the next year.

The U.S., Italy and Australia already pay for PET scans in patients with the six types of cancer the Ontario doctors want to focus on, O'Brien said.

At the moment, only 1,200 cancer patients in Ontario enrolled in clinical trials testing the machines' effectiveness can get a publicly funded PET scan.

O'Brien said a one-time grant from the ministry also pays $675 per scan — about half the cost — for 600 patients in a separate study involving various types of cancer.

"We think what will happen is that the province will be able to say they're funding (the scans), but at a level where it's impossible to actually implement it," O'Brien said.

"They'll have their cake and eat it too. And once again, it's cancer patients that are caught in the middle."

O'Brien said his organization knows of at least 100 patients who have been sent for the scans in the U.S., where the procedure costs $3,000 to $5,000 (U.S.).

At a recent meeting, nuclear medicine specialists called the province's trials "unethical," a message they plan to reinforce Monday at the international conference, where more than half of the sessions focus on PET scanning technology.

PET scanners work by using a radioactive sugar that pools in the cancer cells, allowing the scan to see where the sugar is concentrated. The technology measures the rate at which the sugar is absorbed, distinguishes between benign and malignant tumours, and monitors the spread of the disease.


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